Key findings of the Review are that far more people die in hospital than wish to, and it is estimated that more than 90,000 people are not having their palliative care needs met. Responding to the findings of the report, Chief Executive of Care UK Mike Parish said: "Patients, particularly older people, being left languishing in hospital beds is a serious issue. Hospitals are for acute treatment and are not at all well set up to provide ongoing care for people who have chronic medical conditions or palliative care needs.
"People requiring continuing care are much better off in a fit-for-purpose environment, whether in their own home with specialist support, or in residential facilities which are more appropriate for them - especially if that entails end-of-life care. To keep someone in hospital costs significantly more than the cost of a care bed in a purpose-designed residential home - and is usually not the preferred choice of a patient who would much rather be in more homely surroundings, if they cannot be supported in their own home."
The Review, commissioned by Health Secretary Andrew Lansley, proposes a "fair and transparent" funding system where money is linked to the individual patient. These proposals would guarantee funding regardless of age, or where patients live, and whether they are in a care home, hospital or in their own home.
"Central government, council social service teams and NHS Trusts should work together more closely to address this issue and ‘funding walls’ will need to be torn down", added Mr Parish. "This solution could save the tax payer considerable amounts of money and improves the quality of life for patients who no longer need to be in a hospital environment."
In terms of end-of-life care, the NHS, Department of Health, Age UK and Macmillan Nurses have already worked together to introduce a Gold Standard Framework Care Homes Accreditation scheme. This is designed to acknowledge homes that achieve the highest standards in providing choice and dignity for their residents, as well as giving sensitive and effective support to relatives. Care UK’s Amberley Lodge in Surrey, which provides residential care, nursing care and respite for 59 older people with dementia or a mental disorder, has recently been awarded this accreditation together with the Quality Hallmark Award for its work with residents at the end of their life.
Mr Parish explains: "Individual choice is central to this approach and our care staff have made it increasingly possible for more residents to stay in the home until the end rather than moving to hospital. Others go to hospital for treatment and then return to the home."
Amberley Lodge is just one of Care UK’s 60 residential and nursing homes which provide more than 3,500 places for older people. Care UK also delivers 115,000 hours per week of domiciliary care to around 14,000 people in their own homes and this service often supports people who need palliative care but prefer to be in their own home.
"To be really successful, palliative care must be delivered by professionals from health and social care working collaboratively together with individuals and their families," continues Mr. Parish. "Such an approach can address physical, emotional, spiritual, and social concerns that arise with advanced or chronic illness. In my view, the Palliative Care Funding Review shows the way that we could all work together to better provide for people who need continuing care, and to more fully respect someone’s wishes if they should be reaching the end of their life."
Between 56% and 65% of adults would like to die at home but only 20% do so, with 55% dying in hospital, according to the Review’s findings. At the moment, the amounts that Primary Care Trusts in England spend on end-of-life care vary widely, from £186 per patient in one area to £6,213 in another. Access to services, including round-the-clock nursing care, also depends on where people live.
The ageing population and the increased complexity of needs towards the end of life mean 90,000 more people than at present could be dying in institutions by 2030. Experts who have contributed to the Palliative Care Funding Review say the adoption of its recommendations could reduce deaths in hospital by up to 60,000 a year by 2021, translating into savings of £180 million annually.